RESUMO
Surgical resection remains the mainstay of treatment for advanced non-metastatic renal cell carcinoma (RCC) with tumour thrombus extending into the inferior vena cava (IVC). There is extensive literature regarding the resection of subdiaphragmatic tumour thrombus however there are fewer reports of resection of tumour thrombus that has extended into the right atrium. We report the successful resection of a right renal cell carcinoma with tumour thrombus extending into the right atrium in a patient who had undergone previous coronary artery bypass grafting.
Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Cardíacas/cirurgia , Hipotermia Induzida , Trombose/cirurgia , Veia Cava Inferior/cirurgia , Carcinoma de Células Renais/patologia , Ponte de Artéria Coronária , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/patologia , Veia Cava Inferior/patologiaRESUMO
A left thoracotomy for decortication of an infected haemothorax was performed on a 52-year-old man with a partially infarcted left lower lobe that occurred as a rare complication of a pulmonary venous embolus. Before the completion of surgery, after an uncomplicated 40 minutes of one-lung ventilation, the left lung was temporarily re-expanded to assess air leak. On the resumption of one-lung ventilation the SpO2 fell rapidly to 85%, despite apnoeic oxygenation of the non-ventilated lung. In the absence of evidence of double-lumen tube displacement, intra-pulmonary shunting as a consequence of impaired hypoxic pulmonary vasoconstriction in the newly expanded markedly pathological lung is considered the most likely mechanism.
Assuntos
Complicações Intraoperatórias/terapia , Oxigenoterapia/métodos , Oxigênio/sangue , Pneumonectomia/efeitos adversos , Respiração com Pressão Positiva/métodos , Embolia Pulmonar/cirurgia , Gasometria , Seguimentos , Hemotórax/diagnóstico por imagem , Hemotórax/cirurgia , Humanos , Complicações Intraoperatórias/diagnóstico , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Embolia Pulmonar/diagnóstico por imagem , Medição de Risco , Toracotomia/efeitos adversos , Toracotomia/métodos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The present report describes two similar thoracoscopic procedures performed on the same 81-year-old male patient. Because acute hypoxia had developed during one-lung ventilation on the first occasion, serial blood gases were taken during the second. Also, whereas on the first occasion the non-ventilated lung had been left open to air when one-lung ventilation was initiated, on the second it was connected to an ambient pressure oxygen source with the object of theoretically enabling apnoeic oxygenation during lung collapse. It is argued that this fundamental difference in anaesthetic practice may have contributed to the improved oxygenation that was recorded during the second thoracoscopy.
